{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T20:28:17Z","timestamp":1773865697482,"version":"3.50.1"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":257,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Topconsortia Knowledge and Innovation Life Sciences & Health","award":["ZonMW LSH-2Treat 436001001"],"award-info":[{"award-number":["ZonMW LSH-2Treat 436001001"]}]},{"DOI":"10.13039\/501100022115","name":"Dutch Arthritis Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022115","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Hemics BV"},{"name":"The Department of Rheumatology of the University Medical Centre Utrecht"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The HandScan is a novel method to quickly and objectively quantify RA disease activity using optical spectral transmission in hands and wrists. The aim of this study was to investigate whether treat-to-target (T2T) in early RA patients aimed at \u2018HandScan\u2019 remission is non-inferior to that aimed at ACR\/EULAR 2011 \u2018Boolean\u2019 remission.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a multicentre randomized double-blind, non-inferiority trial. Newly diagnosed RA patients naive to DMARDs were randomized 1:1 to targeting HandScan remission or Boolean remission. At monthly visits, treatment was intensified\/continued\/deescalated according to the respective target following a predefined treatment schedule. Primary outcome was the HAQ score at 18\u2009months, and non-inferiority was tested using a non-inferiority margin of 0.2 with a one-sided alpha of 0.05.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 56 patients included per arm, a remarkably high number was not able to follow the T2T protocol (HandScan: 95%, Boolean: 80%, P\u2009=\u20090.01). The main reason was that patients and\/or rheumatologists felt there was overtreatment (43%, 32%). HAQ at 18\u2009months was 0.21 (95% CI: 0.01\u20130.40) units lower (i.e. better) in the Boolean arm. Thus, non-inferiority was absent for the HandScan target. Sensitivity analyses confirmed this conclusion. The HandScan target required more intensive treatment than the Boolean target, indicating overtreatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Current HandScan remission criteria are not suitable for a T2T strategy in early RA since they may lead to overtreatment and inferior clinical outcomes. Additionally, both treatment targets lead to extraordinarily high non-adherence rates predominantly based on the feeling of overtreatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration<\/jats:title>\n                  <jats:p>International Clinical Trials Registry Platform, www.trialsearch.who.int, NTR6388<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/rap\/rkaf106","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T20:46:59Z","timestamp":1758314819000},"source":"Crossref","is-referenced-by-count":1,"title":["HandScan criteria versus ACR\/EULAR Boolean remission as treatment target in early rheumatoid arthritis: results of a randomized controlled trial"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2892-2248","authenticated-orcid":false,"given":"Matthijs S","family":"van der Leeuw","sequence":"first","affiliation":[{"name":"Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht , Utrecht,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2361-2803","authenticated-orcid":false,"given":"Paco M J","family":"Welsing","sequence":"additional","affiliation":[{"name":"Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht , Utrecht,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janneke","family":"Tekstra","sequence":"additional","affiliation":[{"name":"Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht , Utrecht,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonius A A","family":"Westgeest","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Maxima Medical Centre , Veldhoven,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Klaasen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Meander MC , Amersfoort,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihaela","family":"Gamala","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Noordwest Ziekenhuisgroep , Alkmaar,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes W G","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht , Utrecht,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxime M A","family":"Verhoeven","sequence":"additional","affiliation":[{"name":"Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht , Utrecht,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5544-5785","authenticated-orcid":false,"given":"Jacob M","family":"van Laar","sequence":"additional","affiliation":[{"name":"Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht , Utrecht,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"2025100420065016300_rkaf106-B1","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1136\/annrheumdis-2019-216655","article-title":"EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update","volume":"79","author":"Smolen","year":"2020","journal-title":"Ann Rheum Dis 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Should we continue to ignore this?","volume":"50","author":"Ferreira","year":"2020","journal-title":"Semin Arthritis Rheum"},{"key":"2025100420065016300_rkaf106-B16","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1136\/annrheumdis-2020-217171","article-title":"Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: an individual meta-analysis of 5792 patients","volume":"80","author":"Ferreira","year":"2021","journal-title":"Ann Rheum Dis"},{"key":"2025100420065016300_rkaf106-B17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/ard-2022-223356","article-title":"EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update","volume":"82","author":"Smolen","year":"2023","journal-title":"Ann Rheum Dis"},{"key":"2025100420065016300_rkaf106-B18","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1136\/annrheumdis-2013-205143","article-title":"Intensive combination treatment regimens, including prednisolone, are effective in treating patients with early rheumatoid arthritis regardless of additional etanercept: 1-year results of the COBRA-light open-label, randomised, non-inferiority trial","volume":"74","author":"ter Wee","year":"2015","journal-title":"Ann Rheum Dis"},{"key":"2025100420065016300_rkaf106-B19","doi-asserted-by":"crossref","first-page":"i4205","DOI":"10.1136\/bmj.i4205","article-title":"Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial","volume":"354","author":"Haavardsholm","year":"2016","journal-title":"BMJ"}],"container-title":["Rheumatology Advances in Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/rheumap\/advance-article-pdf\/doi\/10.1093\/rap\/rkaf106\/64274841\/rkaf106.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/9\/4\/rkaf106\/64274841\/rkaf106.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/9\/4\/rkaf106\/64274841\/rkaf106.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:07:00Z","timestamp":1759622820000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/rheumap\/article\/doi\/10.1093\/rap\/rkaf106\/8254455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,9,13]]}},"URL":"https:\/\/doi.org\/10.1093\/rap\/rkaf106","relation":{},"ISSN":["2514-1775"],"issn-type":[{"value":"2514-1775","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025]]},"published":{"date-parts":[[2025]]},"article-number":"rkaf106"}}